Metabolic Dysfunction-Associated Steatotic Liver Disease and Pancreaticoduodenectomy; a Narrative Review

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become increasingly recognized as a postoperative complication in patients undergoing pancreatic surgeries, particularly pancreaticoduodenectomy (PD). Given MASLD’s prevalence and impact on liver function and postoperative outcomes, understanding its incidence, risk factors, and potential interventions is critical for patient care. This study reviewed the relation between MASLD and PD. Studies indicate that MASLD’s incidence ranges from 13.2% to 31% in post-PD patients, with notable variation influenced by factors such as sex, body mass index, and nutritional deficiencies. PD, performed to treat pancreatic or bile duct disease, is associated with considerable postoperative physiological changes. These include disruptions in pancreatic enzyme production, which can impair digestion, metabolism, and potentially contribute to MASLD in susceptible patients. Patients with MASLD post-PD show lower liver-to-spleen attenuation ratios on imaging and often require intensified pancreatic enzyme replacement. A scoring system based on risk factors has been developed to identify patients at higher risk of MASLD and guide preventive nutritional support. MASLD is a prevalent complication post-PD that impacts recovery and treatment continuity in cancer patients. Early risk stratification, tailored enzyme therapy, and ongoing monitoring may reduce MASLD-related liver impairment, enhancing patient outcomes.